Childhood Obesity: Implications for Physical Therapy
by Deidra Debnam, SPT
In Evidence-Based Practice II, I prepared a Critically Appraised Topic (CAT) paper that summarized my systematic search and critical appraisal of research evidence related to the efficacy of interventions focused on diet and nutrition, those focused on physical activity, and those that focused on both in combatting childhood obesity. An interesting observation I made during my review of the research was that in many obesity intervention studies, subjects with physical comorbidities are often excluded from participation. I would later revisit this observation in greater depth after meeting with a physical therapist who works with the Healthy Lifestyle’s Program at Duke Children’s Hospital & Health Center. She explained her clinical encounters as a member of the multidisciplinary team that makes up the lifestyle modification program. She described the numerous physical comorbidities obese children often present with when they seek treatment. Following my discussion with her, I realized that the general “eat less, move more” mantra may not apply to every individual especially if various impairments affect their ability to move.
My capstone presentation, Childhood Obesity: Implications for Physical Therapy, combines the clinical experience of the individual I had preliminary discussions with, with my research findings to promote evidence-based practice among physical therapists who work with children who are obese. The summary of the findings from the current literature will help guide evaluation and treatment interventions for physical therapists that work with this patient population. My capstone project is closely related to the APTA’s vision statement which reads, “Transforming society by optimizing movement to improve the human experience.” With physical activity being the primary component of obesity interventions, it’s important that physical therapists have sufficient knowledge of common physical impairments associated with obesity so they can adequately intervene to promote safe and optimal movement for children who are obese. Physical therapists, as “movement specialists,” can play a significant role in not just facilitating more movement, but better movement.
I presented the findings of my research to first-year UNC Division of Physical Therapy students in PHYT 701:Motor Development and Human Movement Across the Lifespan, a course with objectives that include the “analysis and discussion of normal movement patterns across the life span, as well as current health and wellness issues encountered at various ages.” The objectives of the course demonstrate the appropriateness of my project’s inclusion in the course content. In addition to physical impairments related to mobility, I also included information about the implications of childhood obesity on various systems and the long-term consequences that may arise across the lifespan (e.g., adulthood).
The research on the biomechanical implications of obesity on children was very detailed and too extensive to include in its entirety in the presentation. Although I gave a summary of the research during my presentation, I also created an evidence table for individuals with an interest in study design, methods, and data analysis.
The concepts I learned from Effective Adult Learning: A Toolkit for Teaching Adults and Systematic Effective Instruction: Keys to Designing Effective Presentations to make my presentation more learner friendly helped me develop an effective presentation. I wrote a brief paper that described how I sought to apply the concepts in developing my presentation. Prior to the presentation I had an understanding of what courses students had taken and made references to concepts they learned in Motor Development and Human Movement Across the Lifespan, Introduction to Physical Therapy Assessment and Procedures, Evidence-Based Practice I, Kinesiology & Biomechanics, and Exercise Foundations & Prescription. Additionally, I attempted to make a personal connection to each individual in the room by including childhood obesity statistics for each individual’s home state. Furthermore, regardless of the age demographic individuals work with in the clinic, many of the obesity-related impairments and conditions that occur in childhood are also present in later stages of life and often to a greater extent.
I sought evaluation of my presentation on both the content and my delivery of the information through a paper/pen evaluation form that was distributed to students immediately following the presentation. The feedback from each student was used to compile the results.
Finally, I must acknowledge several individuals who played a role in the success of my presentation: committee member, Andrea Hartzell, PT, DPT, MHS, who helped me develop an important and relevant topic; committee member, Katie Ollendick, PT, MPT, DPT, who helped me identify helpful resources for my project; my classmates, Dale Hamilton, SPT and Michael Murray, SPT, who listened to a full run-through of my presentation and gave me invaluable feedback on ways to improve both my presentation and the delivery; my classmate, Heather Eustis, SPT, who helped me develop a fun, new visual analog scale for my evaluation tool; and my faculty advisor Prue Plummer, PhD for providing me with feedback throughout this capstone process.
PT in Motion recently published an article regarding physical therapists’ role in battling obesity. The article, Acting on a Weight of Evidence, can be accessed by APTA members.
7 Responses to “Childhood Obesity: Implications for Physical Therapy”
Andrea Hartzell
Hi Deidra,
I was very impressed with how in depth and thorough your presentation was. You did a wonderful job synthesizing all the information you gathered and putting into a very well organized manner. The students you taught are going to be better prepared and aware of the complex managment of this population of children they encounter in the clinic setting. Well done!
Joseph Miller
Deidre:
I am most impressed by your capstone. When I read your introduction on the DPT site, my first question was “so what comorbidities do children with obesity develop?” which you answered thoroughly in your powerpoint presentation. I appreciated your detailed explanations of the impact of childhood obesity on medical comorbidities, balance, knee and ankle pathologies, and the kinetic and kinematics of gait. While in Guatemala, I have also been thinking about how pediatric impairments follow individuals throughout the lifespan. Your explanation of the knee being the most common site of musculoskeletal pain will definitely help me screen these areas if I ever see these individuals in the clinic. Your information on SCFE and Blount’s disease was a great review too. The one area that I wondered about throughout your presentation related to prescribing a specific exercise routine for these individuals. You recommended 60 minutes of physical activity per day for these individuals, and obviously these children will not launch into a 60-minute exercise program. Given their current comorbidities and musculoskeletal-related impairments, what recommendations would you give therapists to prevent injuries and maximizing the effectiveness of wellness intervention?
Sabina Beckler
Hey Deidra!
I love your presentation and topic. I have had an interest in obesity for quite some time now but have never seen a presentation that this well organized and comprehensive. Great job!
I also completed my capstone on obesity in the pediatric population with a slightly different approach. One of the aspects that I think can be pretty tough is addressing the topic with the family or parents. Do you have any thoughts on how PTs can address obesity in children with family members? How can PTs not only start a conversation about the importance of maintaining a healthy weight but also come to the point where you specifically ask the parent about their child’s weight, physical activity habits, and typical diet? During my pediatric clinical rotation I found that obesity was rarely, if ever, addressed by PTs. Sometimes I feel like asking questions about weight as part of a questionnaire parents fill out prior to PT could open the door to more conversations. I haven’t seen anything like this in the clinic but it could certainly be useful!
Again, awesome job!
Sabina
Kristel Maes
Deidra,
Great topic! It is clear there is more to it than: eat less, move more.
Couple questions:
– What is the role of the parents in all this? How do we involve them? I can imagine this can lead to very difficult conversations when the parents are also obese and might just perceive their child as a “child with a healthy appetite”.
– In slide 40 it indicates genetics are involved, does this mean that in one family typically every child is obese, any numbers on this?
– How soon should we intervene? Any indications a baby/toddler is at risk for developing childhood obesity?
Thanks
Kristel
Amy Gwynn
Deidra,
I really appreciated your attention to detail in your presentation. It flowed so well, and I’m sure your personal touches like including obesity rates for each state that was represented in the first year class, and connecting your presentation with many of their other courses, the APTA vision statement, ICF, and their course objectives, had a lot to do with the overwhelmingly positive feedback you received! Making a personal connection to the information always helps me remember it better too. I’m so glad you pointed us to the adult learner tool kit, and recommendations for effective presentations–these are definitely tools I look forward to using on future presentations, and in-services.
Could you comment a little bit more about the very interesting observation that many studies on obesity exclude children with physical comorbidities? Were you just realizing that many children who are obese have other physical impairments requiring individualized POCs, and making research more challenging? I just wanted to be sure I understood that point correctly, because it was so interesting.
Similar to Sarah’s comment, I had no idea about a lot of the specific effects of childhood obesity on the musculoskeletal system. Compounding these effects over a lifetime, and considering the increased likelihood of development of so many comorbidities with adult obesity, makes decreasing childhood obesity all the more urgent and important. I was just talking to a friend of mine who’s a personal trainer last week about how she thinks it’s so critical to address obesity from childhood to establish healthy habits from the start, and your presentation only further emphasized that!
Thanks for your great thorough work not only on this topic, but also on your presentation which was so specific to your audience. Is it okay for me to save your presentation for future use?
Amy
Deidra Debnam
Thanks for taking time to check out my Capstone Sarah!! I appreciate the positive feedback and I’m glad you were able to take away some new knowledge regarding the increased susceptibility this population has to physical impairments and other health related conditions. My hope is that it would facilitate a new way we think and reason when developing interventions for these patients. Before beginning the project I, too, thought primarily in terms of diet and exercise interventions with little regard to the physical impairments that may affect safe physical activity.
Sarah van der Horst
D!
First of all, this is a phenomenal presentation. But perhaps more importantly, that picture is AMAZING!
Your comprehensive review of the childhood obesity epidemic and presenting new points of view was excellent. I learned numerous tid bits of knowledge that will help me in years to come like: the effect of obesity on balance, quadriceps extensibility, risk of injury/fracture, and most importantly the consequence of encouraging obese children to increase their activity level without understanding their elevated risk of injury and the need to tailor the program accordingly.
Because of your presentation, I will be more cognizant of the different exercises that I am encouraging the kids of Amigas en Salud to participate in. Thank you!
Really really well done, D!